Department of Radiology, Philippine General Hospital, Manila, Metro Manila, Philippines.
Division of Pediatric Rheumatology, Department of Pediatrics, Philippine General Hospital, Manila, Metro Manila, Philippines.
BMJ Case Rep. 2021 Feb 18;14(2):e239112. doi: 10.1136/bcr-2020-239112.
A 60-year-old woman with rheumatoid arthritis consulted for acute flare. She had elevated disease activity score 28 - erythrocyte sedimentation rate (DAS 28-ESR) of 6.88 and clinical disease activity index (CDAI) of 32. Her 12-joint ultrasound revealed widespread joint effusion. Synovial vascularity scores measured through superb microvascular imaging (SMI) and power Doppler were universally increased. We documented her treatment response 2 weeks after she received a single dose of biosimilar infliximab using clinical and sonographic data. Her DAS 28-ESR and CDAI scores decreased to 4.21 and 7.0, respectively. Reduction in synovial vascularity scores was demonstrated using SMI. While there was near total resolution in joint effusion and tenosynovitis, SMI was able to demonstrate synovial vascularity in joints with no clinical swelling nor tenderness. Musculoskeletal ultrasound and superb microvascular imaging are useful adjuncts in evaluating synovitis in rheumatoid arthritis and documenting treatment response through documentation of synovial vascularity, effusion and tenosynovitis.
一位 60 岁的类风湿关节炎女性患者因急性发作就诊。她的疾病活动评分 28-红细胞沉降率（DAS 28-ESR）为 6.88，临床疾病活动指数（CDAI）为 32。她的 12 关节超声显示广泛的关节积液。通过超微血流成像（SMI）和能量多普勒测量的滑膜血管分数普遍增加。我们在她接受单次生物仿制药英夫利昔单抗治疗后 2 周，根据临床和超声数据记录了她的治疗反应。她的 DAS 28-ESR 和 CDAI 评分分别降至 4.21 和 7.0。SMI 显示滑膜血管分数降低。虽然关节积液和腱鞘炎几乎完全消退，但 SMI 能够显示出在没有临床肿胀或压痛的关节中滑膜的血管分布。肌肉骨骼超声和超微血流成像可作为评估类风湿关节炎滑膜炎和通过记录滑膜血管、积液和腱鞘炎来记录治疗反应的有用辅助手段。
